We are looking for a Care Manager, LPN to join us in leading our organization forward.

McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives. 

McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive.   As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members.  Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.  Learn more about MDwise, Inc. at https://www.mdwise.org/

Position Summary:

Responsible for the review and authorization of all services to the members, utilizing expert knowledge of screening criteria, clinical criteria and research ability if no criteria exists. Uses independent judgment, when necessary, within scope of practice. Participates in the medical management of members in all product lines.  Works with the PCP, the member, the Case Manager or Manager, Med Management and management to promote the delivery of quality services at the most appropriate and cost-effective setting. Performs as the member advocate with emphasis on education regarding managed care, disease management, care management, case management and PCP treatment plans. Monitors member’s utilization patterns for identification of high risk, and under and overuse of services. Collaborates with Case Manager or Manager, Med Management, Medical Director and senior management on complex cases. 

This position is fully remote.

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

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Qualifications:

Required:

A valid current unrestrictive license in the state doing business in, in one of the following:  LPN, LCSW, LMHC, LMSW, LMFT, LPC. Two (2) years clinical experience. One (1) year experience in Utilization Management, Medical Management, Case Management.

Preferred: 

Associate degree in nursing, health care, or related field.  Five (5) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g utilization management, medical management, case management). Five (5) years clinical experience. Understanding of claims administration, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc. Additional Information Schedule: Full-time Requisition ID: 24008146 Daily Work Times: 8:00 am - 5:00 pm Hours Per Pay Period: 80 On Call: No Weekends: No